Medical Clinic III for Oncology, Hematology, Immune-Oncology and Rheumatology, University Hospital Bonn (UKB), Germany; Institute of Experimental Oncology, University Hospital Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany. Electronic address: https://twitter.com/@saal_jonas.
Institute of Experimental Oncology, University Hospital Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany. Electronic address: https://twitter.com/@Doc_Bald.
Lung Cancer. 2024 Mar;189:107505. doi: 10.1016/j.lungcan.2024.107505. Epub 2024 Feb 15.
A large number of patients with non-small cell lung cancer (NSCLC) on immune checkpoint inhibition (ICI) achieve stable disease (SD) as the best overall response, which is associated with heterogeneous outcomes. In this context, complementary biomarkers that improve outcome prediction are needed. We have recently demonstrated that measuring the on-treatment modified Glasgow prognostic score (mGPS), which is based on the two serum markers C-reactive protein (CRP) and albumin, can improve outcome prediction complementary to radiological staging in metastatic renal cell carcinoma. However, this concept has not been assessed for patients with NSCLC on ICI.
We assessed the prognostic and predictive value of on-treatment mGPS at week six in patients with NSCLC treated with atezolizumab or docetaxel in the phase 3 OAK trial (NCT02008227) comprising n = 750 patients and validated the findings in the phase 2 BIRCH (NCT02031458, n = 560).
On-treatment mGPS assessed at week six demonstrated valuable prognostic information (Hazard Ratio (HR) for mGPS low-risk vs intermediate risk 2.34 (95 % CI 1.76-3.11, p < 0.001) and vs high risk 3.56, (95 % CI 2.57-4.91, p < 0.001) in the atezolizumab-treated subgroup. On-treatment mGPS predicted overall survival more accurately than imaging using RECIST criteria (concordance index: on-treatment mGPS 0.646 (95 % CI 0.615-0.677) vs RECIST 0.606 (95 % CI 0.575-0.637)). On-treatment mGPS provides additional prognostic information to imaging-assessed treatment response at first staging, especially for the patient subgroup with SD. These findings were validated in the BIRCH trial.
We highlight the novel concept of integrating on-treatment mGPS for improved outcome prediction in conjunction with radiological imaging for patients with NSCLC on ICI.
大量接受免疫检查点抑制 (ICI) 的非小细胞肺癌 (NSCLC) 患者达到最佳总体反应稳定疾病 (SD)，这与异质性结局相关。在这种情况下，需要互补的生物标志物来改善预后预测。我们最近证明，测量治疗中的改良格拉斯哥预后评分 (mGPS)，该评分基于两种血清标志物 C 反应蛋白 (CRP) 和白蛋白，可改善转移性肾细胞癌的放射分期的补充预后预测。然而，这一概念尚未在接受 ICI 的 NSCLC 患者中进行评估。
我们评估了在 OAK 试验 (NCT02008227) 中接受阿替利珠单抗或多西他赛治疗的 NSCLC 患者治疗第 6 周时治疗中 mGPS 的预后和预测价值，该试验包括 n=750 例患者，并在 BIRCH 试验 (NCT02031458，n=560) 中验证了该结果。
治疗第 6 周时评估的治疗中 mGPS 提供了有价值的预后信息（mGPS 低危与中危风险比为 2.34 (95% CI 1.76-3.11，p<0.001)，与高危风险比为 3.56，(95% CI 2.57-4.91，p<0.001)，在阿替利珠单抗治疗亚组中。与使用 RECIST 标准的影像学相比，治疗中 mGPS 更准确地预测总生存期（一致性指数：治疗中 mGPS 0.646 (95% CI 0.615-0.677) 与 RECIST 0.606 (95% CI 0.575-0.637)）。治疗中 mGPS 为 ICI 治疗的 NSCLC 患者的影像学评估治疗反应提供了额外的预后信息，特别是对于 SD 患者亚组。这些发现得到了 BIRCH 试验的验证。
我们强调了一种新的概念，即整合治疗中的 mGPS 以改善预后预测，同时结合放射影像学用于接受 ICI 的 NSCLC 患者。
